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Rhode Island rates for HCPCS 64495

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; third and any additional level(s) (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $1,348.96 / $3,981.07
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,778.28 / $1,778.28 / $1,778.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $93.33 / $316.23
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$32.36 / $288.40 / $380.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $389.05 / $645.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $83.18 / $147.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $107.15 / $177.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $1,412.54 / $6,456.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $91.20 / $165.96